Management der Myopieprogression mittels Kontaktlinsen

Management der
Myopieprogression mittels
Kontaktlinsen
Dr. Michael Bärtschi
PhD (Biomedicine), MSc. et M.M.E., FAAO
Eyeness AG, kontaktlinsenstudio baertschi, Bern / Schweiz
mbaertschi@eyeness.ch
Disclosure
•  None
•  Recognition for :
Dr. Kate Johnson and
Dr. Martin Lörtscher
Goals
•  Why bother with Myopia Control?
–  Risk Profile
•  Understand the science of Myopia Control
–  Central vs peripheral Retina Imaging
–  Dual Vision and Ortho-Keratology
•  Putting Science into daily Praxis
–  Patient Selection and Management
Why Myopia Control?
Increased'risk'
Why Myopia Control?
Cataract&(PSCC)&
Glaucoma&
Retinal&
detachment&
C1.00'to'C3.00'
2'
4'
4'
C3.00'to'C6.00'
3'
3'
10'
C6.00'or'more'
5'
4'
16'
Lim'et'al,'IOVS'1999;'Mitchell'et'al,'Ophthalmol'1999;'The'Eye'Disease'CaseCControl'Study'Group,'Am'J'Epidemiol,'1993;''
Lim et al, IOVS 1999; Mitchell et al, Ophthalmol 1999; The Eye Disease Case-Control Study Group, Am J Epidemiol,
Beijing'Rhegmatogenous'Retinal'Detachment'Study'Group,'Ophthalmol'2003.'
1993; Beijing Rhegmatogenous Retinal Detachment Study Group, Ophthalmol 2003.
Why Myopia Control?
•  Brennan (CLAE 2012) showed that slowing
down the progression rate is eminent for
prevention of high myopia (> - 6dpt).
Reducing myopia
progression by
Reduction in frequency of
high myopia
33%
73%
50%
90%
Etiology of Myopia
•  Genetics
Parents:
•  One myopic parent = 2x risk
•  Two myopic parents = 5-6x risk
Ethnicity:
•  20% - 30% in USA, Europa, Ozeanien
•  Over 80% in some parts of Asia
Morgan et al 2005, Pacella et al 1999; Zadnik 1997; Rose et al 2008, Ip et al 2008; Azizoglu et
al2011; Junghans et al 2005; Morgan et al 2005
Etiology of Myopia
•  Environment
–  Less than 1.5hours outdoor activity PLUS
–  high near work demand more than 3hours
beside school / college
Jones-Jordan et al 2010
?
D
n
i
m
a
t
i
V
f
o
k
c
a
L
?
g
n
i
s
?
Focu
e
c
n
e
g
r
e
v
Con
Etiology of Myopia
•  Central Defocus
Myopic
defocus
Hyperopic
defocus
Etiology of Myopia
•  Peripheral Defocus (Smith et al 2007)
Etiology of Myopia
•  Relative peripheral Hyperopia
(Relative Peripheral Defocus RPD or
Relative Peripheral Refractive Error RPRE)
Etiology of Myopia
Chen et al. (2010)
Myopia Control Strategies
Method
Reduction in axial length grow
Atropine
30% - 77%
Monovision
48%
(✔)
Normal RGP or Hydrogels
0% - 5%
✗
Spectacles (PAL, Bifocal)
12% - 55%
(✔)
Spectacle MyoVision (Refractive
Radial Gradient)
0% - 29%
✗
Multifocal Hydrogel (DualFocus,
Proclear D, Biofinity D)
29% - 69%
✔
Orthokeratology
32% - 100%
✔
✔
Monovision
•  Monovision Study Design Phillips (2005)
•  13 Children (One eye full correction, the other
eye max 2.00 D under correction)
•  Years of age 11 – 13
•  Monitoring
–  Cyclo Autoref
–  Ultrasound axial length
Monovision Results
•  The full corrected eye was accomodating for
near targets!
•  Myopia Progression
N = 13
Corrected eye
Undercorrected eye Reduction of
Progression in
%
SER (D/yr)
-0.72 ± 0.32
-0.32 ± 0.30
56%
VCD (mm/yr)
0.29 ± 0.11
0.15 ± 0.12
48%
Time
18.7 Month
Binocular Undercorrection
•  Chung et al (2002) 0.75 D undercorrection
N= 94
Age 9 -14
Full
Correcti
on
+ 23%
P < 0.001
Refractive Radial Gradient
•  Reduction of relative peripheral Hyperopia
–  210 Children, years 6 – 16
–  Cyclo autorefraction & Biometry
–  4 Groups
•  SV Spex (n=50)
•  3 new Typ SV
•  Result: same effect on myopia progression
in all 4 groups
Sankaridurg et al, 2010
Biofinity Bifocal (D)
Yellow = Distance / Red = Treatment zones
Biofinity Bifocal (D)
ü  Good starting point for lower grade or
slower progressing Myopia.
ü  Different Add. options. (+1.0/+1.5/+2.0/+2.5)
ü  Daily Wear or Extended Wear possible.
Dual Focus contact lens
(MySight Cooper)
Photopic
Mesopic
Child's pupil
Clear image
2.00D myopic defocus
Blue = Distance / Red = Treatment zones
Anstice & Phillips (2011)
Clear image
‘ual-focus’ A(DF) contactDFlens
@ Distanz
(& Bi-focal)
2.00 D myopic defocus
B
DF @ Nähe
C
Bi-focal @ Nähe
Simultaneous Defocus Results
Study
Anstice &
Phillips
2011
control
Age
(yrs)
n
Contralateral
11-14 40
SVCL
Reduction in
myopia
progression (SER)
Reduction in
eye
elongation
37%
49%
Lam et al.
2013
SVCL
8-13
49
25%
32%
Walline,
Greiner et al
2013
Historical
SVCLs
8-11
31
50%
29%
Orthokeratology
Orthokeratology Hypothesis
•  Ortho-K changes the relativ peripheral
defocus from Hyperopic to a Myopic
defocus
Kang & Swarbrick (2011)
Orthokeratology Results
n
Drop
-out
Reduction
in axial
elongation
7 - 12
43
19%
46%
SCLs
8 - 11
40
30%
55%
Kakita et al 2011
Specs
8 - 16 105
23%
36%
Hiraoka et al 2012
Specs
8 - 12
43
27%
31%
Santo-Rubido
2012
Specs
6 - 12
61
13%
32%
Cho & Cheung
2012
Specs
7 - 10
78
24%
43%
control
Age
(yrs)
Cho et al 2005
Specs
Walline et al 2009
Study
Multifokal Orthokeratology (MOK)
Loertscher / Phillips et al (2014)
Conventional OK + Dual Focus optics
=
MOK
MOK Fluorescein Pattern
Reverse Zone
Treatment
Zone
Correction Zone
Distance Vision
© Falco
MOK Topography
Correction Zone
Distance Vision
Reverse Zone
Treatment
Zone
Pupil
© Lörtscher
MOK Axial length
Phillips 2005
0.29mm
Loertscher / Phillips et al (2014)
0.2
ChnageinAL(mm)
*p=0.009 *p=0.003
*p=0.007
*p=0.001
0.1
0
-0.1
MOK
OK
-0.2
-6
0
6
12
BLOM0OM1OM2OM3
n=16
Time(Months)
18
MOK Comparison
Loertscher / Phillips et al (2014)
Orthokeratology
Spectacle
MOK - Choriodal Thickness
Loertscher / Phillips et al (2014)
0.06
NS
NS
*p=0.013
*p=0.025
ChnageinCHR(mm)
0.04
0.02
0
-0.02
-0.04
MOK
OK
-0.06
-6
0
6
12
18
BLOM0OM1OM2OM3
Time(Month)
MOK – RPR
Loertscher / Phillips et al (2014)
P = 0.119
n=16
MOK – Theory
•  Central defocus causes increasing thickness of
Chorioidea
–  Cholinergic antagonists (e.g. atropine) responsible for
thickening of Choriodea and prevent the development
of defocus driven myopia in animals
•  Central– Simultaneous defocus seems to have a
bigger impact than peripheral defocus alone
•  Additive Effect of central and peripheral defocus
is possible
MOK – Fitting principles
•  Fitting accordingly to normal Ortho-K
–  Distance Vision need an extra week longer to
fully achieve
–  Corneal Astigmatism can be corrected up to
4.0 D
–  6month follow up
–  yearly exchange of contact lenses
Myopia Risks vs CL Risks
VS
Myopia Risks vs CL Risks
Gariano et al 2004, Ivanisevic et al 2000, Li et al 2003, Stapleton et al 2008, Mitchell et al 1999, Wilkes et al 1982, Lim et al 1999
Myopia Risks vs CL Risks
•  Lifetime risk of retinal detachment in >5D
myopia is 3.5x higher than MK with DD
contact lenses
–  2.5x higher with loss of BCVA with EW SiHy
•  Lifetime risk of Glaucoma in >1D myope is
2x higher than risk of MK with loss of
BCVA with EW SiHy
Summary
•  There is evidence today that Myopia Control is
working extremely well
–  Eye care practitioner are responsible to be active
and to inform patients properly
•  Biometry (axial eye length measurement) as the
only valuable reference for Myopia control
should be done yearly
Summary
•  As we deal with young adults and children,
proper instructions on handling, after care
plan and emergency management is vital !
Darf ich Herzlichen
Ihre FragenDank
beantworten
?
!
Team Eyeness AG, Bern